Expert: Scott F. Gillman, DC, DACBSP - 1/5/2007

Question
In August after my last chemotherapy treatment (for breast cancer - left side), I spent several days lying on my right side propped up on pillows. A few days after that I started experiencing a pain under my right shoulder blade. I had a massage and the pain subsided to a mild discomfort and for the most part went away. At the end of September, I had my port-a-cath removed (it was on my right side below my collar bone). About 3 weeks ago the pain under my right shoulder returned with a corresponding pain in my chest. The area around the port-a-cath site gets tender and sometimes swollen. The pain in my chest is near the sternum and is often a burning sensation. The pain also radiates across my chest to my back, down my right arm and up the back of my neck. Certain activities are very difficult to do - deep breathing, turning over in bed, turning my head to the left or right, reaching my arms back ...

I have had a chest x-ray which showed no skeletal problem. My doctor suggested a strained muscle or repetitive strain injury. I have been to a massage therapist (MT) and this has helped a bit. The MT suggested that my problem might be a subluxated rib and thought a chiropractor might be able to help.

I've never been to a chiropractor and don't know what to expect.

Answer
Karen,

Your question, I'm assuming, regards what to expect if you go to a chiropractor.  DC's are trained to provide diagnosis and treatment of musculoskeletal conditions, primarily spine conditions.  Treatment should involve manual, or hands-on care, as well as a variety of other non-surgical, non-pharmacologic methods.  Unfortunately, there are some doctors of chiropractic (DC) that have peculiar examination and practice methods, and fall clearly away from good standards of care.  The modern doctor of chiropractic is supposed to evaluate a patient like any other doctor: History, Physical Exam, Report of Findings, Discussion of Treatment Options, Providing the most logical treatment course, using an initial trial of care to determine a patient’s response (in your case about 3-6 treatment sessions), and whenever possible track the outcome (e.g. improvement in daily activities such as sleeping or lifting).  

First: you need a thorough, textbook standard, physical examination that includes orthopedic and neurologic tests and myfascial assessment, to evaluate why you have your symptoms (e.g. is it really a rib or is it referred pain from a chest, cervical spine, or thoracic outlet structure?).  Second: avoid practitioners that are going to base your diagnosis on peculiar testing, such as putting your tongue against your cheek while testing the strength of your arm, putting herbs or crystals on you, or producing fancy computer pictures of your back with color-coded bars and numbers to determine how well you are.  Beware of these computer-generated printouts that show colors or bars to highlight “subluxations” of your spine.  While these appear to be high-tech, they are not valid for determining your care.  I don't care what sort of physiological explanation they can come up with, these unsubstantiated methods don't constitute good diagnostic methods.  If a practitioner seems kooky, he/she likely is.   

Remember that most people have good experiences with their chiropractic care.  I'll bet that if you ask around, you'll find a DC you'll like.  It's unfortunate that your massage therapist or your primary care doctor doesn't have a few connections.

I would suggest you visit the American Chiropractic Association's web site for more information: www.amerchiro.org    Also, the Massachusetts Chiropractic Society has a nice web site: www.masschiro.org;  

'Best of luck.

Dr. G
www.drgillman.com